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New Hampshire rates for HCPCS L0625

Lumbar orthosis (LO), flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.47 / $36.47 / $43.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.18 / $28.30 / $36.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.67 / $41.67 / $49.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.19 / $36.19 / $37.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $38.15 / $42.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $32.43 / $42.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.44 / $52.44 / $161.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $32.31 / $38.36
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.70 / $51.24 / $75.31